Hypertension is a prevalent issue in dialysis patients. Mechanisms of Hypertension in ESRD patients Sodium and Volume Overload Sympathetic Overactivity Renin Angiotensin System Activation Sodium and Volume Overload The cornerstone of blood pressure control is volume management. In non ESRD patients with hypertension (HTN), sodium/ volume overload is a reason for an inability
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Amyloidosis is another relatively common systemic condition that causes nephrotic syndrome with unique kidney pathology. Approximately 2% of native kidney biopsies will show amyloidosis. What is amyloidosis? Amyloidosis is a syndrome where proteins deposit in tissues in a specific misfolded pattern forming what is called beta pleated sheets. These protein deposits result in
Hypercalcemia is of interest to both nephrologists and endocrinologists. Why nephrology? Hypercalcemia may cause acute kidney injury (AKI) Hypercalcemia, in specific primary hyperparathyroidism, is associated with nephrolithiasis (kidney stones). Secondary and Tertiary hyperparathyroidism is a complication of chronic kidney disease (CKD) and end stage renal disease (ESRD) primarily managed by nephrologists. Bottom line:
Mineral bone disease in dialysis patients refers to assessment and management of Phosphorus, Calcium, and Parathyroid Hormone (PTH) Pathophysiology The kidney normally is responsible for excretion of phosphorus and conversion of inactive - 25- hydroxyvitamin D to active - 1,25-hydroxyvitamin D via the enzyme 1 alpha-hydroxylase. Therefore with kidney failure there is: Impaired
Diabetic kidney disease is the most common cause of kidney failure. 20-40% of diabetics get diabetic kidney disease. It typically occurs after 5 years of diabetes. Remember that the true duration of diabetes is often not known in patients with type 2 as the patient may have had the condition undiagnosed for a
See my story about how I went from thinking intermittent fasting was impossible to making it a routine habit. What I learned Intermittent Fasting is Not Hard The Body Adapts It Gave Me Confidence The health benefits of intermittent fasting are outlined in this article from the New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMra1905136
This article will address: Diagnosis of metabolic alkalosis and assessment of compensation. Approach to differential diagnosis/ underlying cause of metabolic alkalosis. Metabolic Alkalosis Diagnosis Elevated pH (>7.42) Elevated serum HCO3- (>26) Elevated pCO2 (compensation) What you will initially see (either in the hospital or outpatient setting) is an elevated serum HCO3. This can
Nutrition is an important part of managing chronic dialysis patients so much so that each unit has a registered dietician. Things that I focus on when rounding on a dialysis patient include: Albumin - Malnutrition and protein energy wasting Potassium Bicarbonate - Acid Base status Vitamins - B complex/ C Diabetes Albumin -
MPGN is not a specific disease, it is a pattern of injury seen on light microscopy of kidney biopsy. Membrano - Diffuse thickening of glomerular capillary walls Proliferative - Increased number of cells in the glomeruli Therefore MPGN is when glomeruli have both thickened capillary walls and an increased number of cells. This
